BRONCHOSCOPIC DIAGNOSIS OF PULMONARY INFECTIONS IN A HETEROGENEOUS, NONSELECTED GROUP OF PATIENTS

Fiberoptic bronchoscopy with bronchoalveolar lavage and protected spec imen brush technique has become an established method for etiologic di agnosis in severe forms of pulmonary infections during recent years. I n this study, including 62 bronchoscopies in 53 patients, a standardiz ed program, covering all important pulmonary pathogens, has been evalu ated in a heterogeneous group of patients. Results providing therapeut ic guidelines were obtained in 53 percent (16/30) of the immunocomprom ised patients (including 5 bronchoscopies on HIV-positive patients), b ut only 19 percent (6/32) of the immunocompetent patients (p<0.001). W e conclude that bronchoscopy is of great value for diagnosing pulmonar y infections in immunocompromised patients. In immunocompetent patient s, the diagnostic yield is lower and the indication for bronchoscopy m ust he established for each individual patient based on clinical impor tance, resources, and risk. When bronchoscopy is performed, we believe that a standardized program like ours reduces the risk of missing imp ortant pathogens.